Backup surgical instrument system and method

ABSTRACT

A method for preparing surgical kits for use during a surgery includes preparing a pre-operative surgical plan for a patient and selecting a set of surgical instruments based on the pre-operative surgical plan. The set of surgical instruments includes at least a general instrument, a first size-specific instrument, a patient-specific instrument, and a surgeon-specific instrument. The general instrument is selected from a predetermined group of off-the-shelf instruments. The first size-specific instrument has a first size selected from predetermined sizes. The patient-specific instrument includes a three-dimensional contoured engagement surface configured to nest into a portion of a native anatomy in a single location. The surgeon-specific instrument is selected based on a surgeon preference and is a different instrument than the selected general instrument, first size-specific instrument, and patient-specific instrument. The method further includes preparing a surgeon instrument kit containing the set of surgical instruments in sterilized form.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No. 13/527,981, filed on Jun. 20, 2012, now issued as U.S. Pat. No. 9,918,740, which claims the benefit of U.S. Provisional Application Ser. No. 61/499,756, filed on Jun. 22, 2011.

This application is a continuation-in-part of U.S. application Ser. No. 13/045,169 filed on Mar. 10, 2011, which claims the benefit of U.S. Provisional Application No. 61/446,660, filed on Feb. 25, 2011.

This application is a continuation-in-part of U.S. application Ser. Nos. 13/041,469, 13/041,495, 13/041,665 and 13/041,883, each filed on Mar. 7, 2011, each of which is a continuation-in-part of U.S. application Ser. No. 12/978,069 filed Dec. 23, 2010, which is a continuation-in-part of U.S. application Ser. No. 12/973,214, filed Dec. 20, 2010, which is a continuation-in-part of U.S. application Ser. No. 12/955,361 filed Nov. 29, 2010, which is a continuation-in-part of U.S. application Ser. Nos. 12/938,913 and 12/938,905, each filed on Nov. 3, 2010, and each of which is a continuation-in-part of U.S. application Ser. No. 12/893,306, filed on Sep. 29, 2010, which is a continuation-in-part of U.S. application Ser. No. 12/888,005, filed on Sep. 22, 2010, which is a continuation-in-part of U.S. application Ser. No. 12/714,023, filed on Feb. 26, 2010, which is: a continuation-in-part of U.S. application Ser. No. 12/571,969, filed on Oct. 1, 2009, which is a continuation-in-part of U.S. application Ser. No. 12/486,992, filed on Jun. 18, 2009, and is a continuation-in-part of U.S. application Ser. No. 12/389,901, filed on Feb. 20, 2009, now U.S. Pat. No. 8,133,234, issued on Mar. 13, 2012, which is a continuation-in-part of U.S. application Ser. No. 12/211,407, filed on Sep. 16, 2008, which is a continuation-in-part of U.S. application Ser. No. 12/039,849, filed on Feb. 29, 2008, which: (1) claims the benefit of U.S. Provisional Application No. 60/953,620, filed on Aug. 2, 2007, U.S. Provisional Application No. 60/947,813, filed on Jul. 3, 2007, U.S. Provisional Application No. 60/911,297, filed on Apr. 12, 2007, and U.S. Provisional Application No. 60/892,349, filed on Mar. 1, 2007; (2) is a continuation-in-part U.S. application Ser. No. 11/756,057, filed on May 31, 2007, now U.S. Pat. No. 8,092,465, issued on Jan. 10, 2012, which claims the benefit of U.S. Provisional Application No. 60/812,694, filed on Jun. 9, 2006; (3) is a continuation-in-part of U.S. application Ser. No. 11/971,390, filed on Jan. 9, 2008, now U.S. Pat. No. 8,070,752, issued on Dec. 6, 2011, which is a continuation-in-part of U.S. application Ser. No. 11/363,548, filed on Feb. 27, 2006, now U.S. Pat. No. 7,780,672 issued on Aug. 24, 2010; and (4) is a continuation-in-part of U.S. application Ser. No. 12/025,414, filed on Feb. 4, 2008, which claims the benefit of U.S. Provisional Application No. 60/953,637, filed on Aug. 2, 2007.

The disclosures of all the above applications are incorporated herein by reference.

INTRODUCTION

A surgical or instrument kit containing a set of sterilized instruments and other implements to be used during a surgical procedure can be prepared in advance and provided to a surgeon. For various reasons, such as mishandling, a particular instrument may need to be replaced during surgery. For example, a single instrument may become contaminated. Previously, replacing the instrument required the surgeon to wait while the contaminated instrument was cleaned and re-sterilized or a new kit containing another entire set of sterilized instruments was opened. The present teachings provide a method for preparing a surgeon instrument kit and backup kits for use together during a surgical procedure as a set. Each of the backup kits can contain a single replacement instrument. Collectively, the backup kits can contain replacement instruments, including implant components, that can be selectively used to replace selected instruments of the surgeon instrument kit.

SUMMARY

The present teachings provide a method for preparing surgical kits for use during a surgery. The method includes preparing a pre-operative surgical plan for a patient and selecting a set of surgical instruments based on the pre-operative surgical plan. The set of surgical instruments includes at least a general instrument, a first size-specific instrument, a patient-specific instrument, and a surgeon-specific instrument. The general instrument is selected from a predetermined group of off-the-shelf instruments. The first size-specific instrument has a first size selected from predetermined sizes. The patient-specific instrument includes a three-dimensional contoured engagement surface configured to nest into a portion of a native anatomy in a single location. The surgeon-specific instrument is selected based on a surgeon preference and is a different instrument than the selected general instrument, first size-specific instrument, and patient-specific instrument. The method further includes preparing a surgeon instrument kit containing the set of surgical instruments in sterilized form.

The present teachings further provide another method for preparing surgical kits for use during a surgery. The method includes preparing a surgeon instrument kit containing a plurality of surgical instruments and delivering the surgeon instrument kit to an operating room for use by a surgeon during the surgery. The method further includes preparing a backup kit containing only one replacement instrument for a corresponding one of the surgical instruments and stocking the backup kit to a mobile storage cart. The method further includes staging the mobile storage cart relative to the operating room prior to the surgery and selectively replacing the one of the surgical instruments with the replacement instrument during the surgery.

The present teachings further provide a surgical kit set including a first surgical kit for use by a surgeon during a surgery. The first surgical kit contains at least a general instrument, a first size-specific instrument, a patient-specific instrument, and a surgeon specific instrument. The first size-specific instrument has a first size relative to an anatomy of a patient. The patient-specific instrument includes a three-dimensional contoured engagement surface configured to nest into a portion of a native anatomy in a single location. The surgeon-specific instrument is a different instrument than the general instrument, the size-specific instrument, and the patient-specific instrument. The surgical kit set can further include a second surgical kit for selective use with the first surgical kit. The second surgical kit is separate from the first surgical kit and contains only one replacement instrument for a corresponding one of the general instrument, the first size-specific instrument, the patient-specific instrument, and the surgeon-specific instrument.

Further areas of applicability of the present teachings will become apparent from the description provided hereinafter. It should be understood that the description and specific examples are intended for purposes of illustration only and are not intended to limit the scope of the present teachings.

BRIEF DESCRIPTION OF THE DRAWINGS

The present teachings will become more fully understood from the detailed description and the accompanying drawings, wherein:

FIG. 1 is a flow chart illustrating an exemplary method for preparing a surgeon instrument kit and associated backup kits according to the present teachings;

FIG. 2 is another flow chart further illustrating the method shown in FIG. 1;

FIG. 3 is a perspective view of a surgeon instrument kit according to the present teachings;

FIG. 4 is a perspective view of a mobile storage cart for backup kits according to the present teachings;

FIG. 5 is a perspective view of another mobile storage cart for backup kits according to the present teachings; and

FIG. 6 is a flow chart illustrating an exemplary method for performing a surgical procedure using a surgeon instrument kit and a mobile storage cart containing backup kits according to the present teachings.

FIG. 7 is a perspective view of an individually packaged general surgical instrument.

FIG. 8 is a perspective view of an individually packaged surgeon-specific instrument.

FIG. 9 is a perspective view of an individually packaged patient-specific instrument.

DESCRIPTION OF VARIOUS ASPECTS

The following description is merely exemplary in nature and is in no way intended to limit the present teachings, applications, or uses. For example, although some of the present teachings are illustrated for a knee implant, the present teachings can be used for any orthopedic implant.

The present teachings provide a method for preparing a surgeon instrument kit and associated backup kits for a surgical procedure based on a pre-operative surgical plan. The surgeon instrument kit can include at least one each of a patient-specific instrument, a size-specific instrument, a surgeon-specific instrument, and a general surgical instrument sterilized and packaged together in a single receptacle or container that holds the instruments in sterilized form. The instruments of the surgeon instrument kit can be selected during preparation of the pre-operative surgical plan.

The backup kits can include replacement instruments for selected instruments of the surgeon instrument kit and, optionally, instruments varying in size from the instruments of the surgeon instrument kit. The replacement instruments can be sterilized and individually packaged in containers that hold the instruments in sterilized form. In other words, each backup kit can contain a single replacement instrument for one of the instruments of the surgeon instrument kit. The instruments of the surgeon instrument kit and the backup kits can include instruments necessary or useful for the surgical procedure and/or implant components. For purposes of the present disclosure, the term instrument will generally be used to refer to any instrument, implant, or the like, to be used during a surgical procedure. The instruments can be of the non-disposable or the disposable type. The surgeon instrument kit and the backup kits can include non-disposable instruments, disposable instruments, or a combination thereof.

The backup kits can be stocked to a mobile storage cart and can be staged relative to an operating room. The surgeon instrument kit can be delivered to the surgeon. During surgery, the surgeon can use instruments and other components of the surgeon instrument kit. When desired, the backup kits can be selectively removed from the mobile storage cart and delivered to the surgeon to replace separate or individual components of the surgeon instrument kit that have, for example, malfunctioned, been mishandled, or are of an incorrect size.

The method can integrate a patient's anatomic and medical information with interactive participation by a surgeon to select and manufacture an implant or implant component for use with a particular patient. The method can further integrate a surgeon's recommendations or preferences to select a particular instrument or instruments from available alternatives that are to be used during the surgical procedure. The implant components and other instrumentation can be included in a single package, the surgeon instrument kit, and provided to a surgeon for a specific patient.

Referring to FIGS. 1-2, flowcharts illustrating an exemplary method 100 for preparing instrument kits for use together during an orthopedic procedure or surgery according to the present teachings are presented. While described for an orthopedic procedure, it will be appreciated that the method 100 is applicable to other surgical procedures.

The method 100 can be implemented in a computer network that facilitates interaction between a medical facility where the orthopedic procedure is to be performed and manufacturers of the instrument kits. The computer network can be configured to transmit and display information to various users and to receive input from the users. The computer network can include wired and/or wireless connections. One or more aspects of the method 100 can be implemented by one or more computer programs executed by one or more processors. The computer programs include processor-executable instructions that are stored on a non-transitory tangible computer readable medium. The computer programs may also include stored data. Non-limiting examples of the non-transitory tangible computer readable medium are nonvolatile memory, magnetic storage, and optical storage. An exemplary computer network and related devices are described in commonly assigned co-pending application Ser. No. 12/872,663, filed on Aug. 31, 2010, and entitled “Method and Apparatus for Manufacturing an Implant,” the disclosure of which is incorporated herein by reference.

At 110, a pre-operative surgical plan for an orthopedic procedure to be performed on a specific patient can be prepared. The pre-operative surgical plan can be prepared by various methods. With particular reference to FIG. 2, an exemplary method for preparing the pre-operative surgical plan is presented. At 112, a portion of the patient's anatomy affected by the orthopedic procedure and an implant to be implanted can be characterized and detailed.

The characterization can be performed using various imaging methods capable of obtaining image information for the affected anatomy including, for example, soft and hard tissues. The tissues can include bone, bone joints (with or without cartilage), ligaments, or other soft tissue. The imaging methods can include, for example, magnetic resonance imaging (MRI), computed tomography (CT), ultrasound, radiography or x-ray, cameras, and other devices.

The image information can be obtained at a medical facility or a doctor's office and can be stored on a non-transitory tangible computer readable medium such as, for example, non-volatile memory, a compact disc (CD), a digital video disc (DVD), a flash memory device, or other storage device. The image information can be communicated to a user, such as a surgeon or a manufacturer of the implant, by various methods. For example, the image information can be transmitted electronically via the internet or worldwide web using appropriate information transfer protocols. The electronic transmissions can include e-mail or other digital transmission to any electronic device to which electronic information can be transmitted such as, for example, a computer, a personal digital assistant (PDA), a cell phone, etc.

Handheld devices can provide access to the electronic transmissions or file transfer protocols to transfer or access the image information or image data files. The handheld devices can include processors that execute various computer programs for accessing, viewing, and manipulating the image data files. Alternately or additionally, the handheld devices can access servers on a network that process the image data files. The servers can process the image data files while displaying images to a user, such as the surgeon, and receiving input through the handheld devices. In various implementations, the handheld devices can be a client on the network that does not process and edit the image data files or other pre-operative surgical plan data files.

At 114, a three-dimensional model or image of the bone or joint can be created from the image information obtained at 112. The model can include the bone or joint with or without associated soft tissue or related anatomy. The model can be created using commercially available computer modeling software from various vendors or developers such as, for example, Materialise USA of Ann Arbor, Mich.

At 116, soft tissue information created at 114 can be used to evaluate whether soft tissue associated with the affected anatomy should be modified, removed, or repaired. Modification, removal, or repair of the soft tissue may be desired to restore alignment of the joint, remove torn or diseased soft tissue, repair ligaments, or provide natural or artificial ligament grafts.

At 118, a preliminary pre-operative surgical plan for the orthopedic procedure can be prepared for review by various users, such as the surgeon or other medical professionals. The preliminary pre-operative plan can be prepared based on recommendations by the surgeon, an instrument manufacturer, and/or other users. The preliminary pre-operative surgical plan can include plans for various bone resections, sizes and types of implants, and various geometric requirements, including relevant dimensions of particular features.

The preliminary pre-operative surgical plan can further include recommendations for particular procedures or implants and associated instruments to be used in the orthopedic procedure. The recommendations can be based on surgeon preference. The surgeon preference can be a preferred procedure and/or a preferred instrument. For example, the surgeon may have a preferred procedure among several accepted procedures for performing a particular surgical task. The surgeon may prefer a particular instrument from among the available instruments for performing a particular surgical task. The surgeon may also prefer particular resection levels and/or other surgical parameters.

The preliminary pre-operative surgical plan can be in the form of digital images that can be interactively viewed using commercially available software, such as the computer modeling software referenced above. The preliminary pre-operative surgical plan can be devised to obtain a healthy or near healthy anatomical orientation after the orthopedic procedure. The healthy anatomical orientation can be based on a natural or pre-injury anatomy or a mechanically correct or efficient anatomical orientation.

At 120-130, the preliminary pre-operative surgical plan can be reviewed by a surgeon and/or other user. The preliminary pre-operative surgical plan can be communicated to the surgeon or other user either electronically or by land mail, and either in digital or hard copy form. Generally, the surgeon and/or other user can review various aspects of the preliminary pre-operative surgical plan and can work interactively until the pre-operative surgical plan is approved at 132.

More specifically, at 120 the surgeon can review the resection planes shown in the images of the patient's anatomy and can make changes in the location, size, and orientation of the resection planes. The surgeon can further review various intra-operative procedures for joint preparation and osteophyte/protrusion removal.

Based on the preliminary pre-operative surgical plan and the patient information, the surgeon can select an implant design at 122, and associated alignment guide design at 124. At 122, the surgeon can recommend a method of designing the implant. Specifically, the surgeon can select one of a custom implant, a semi-custom implant, or an off-the-shelf implant, as discussed below. It will be appreciated that, based on the surgeon's input at 120-124, the preliminary pre-operative surgical plan can be modified at 118. For example, the preliminary pre-operative surgical plan can be modified based on the surgeon's input or preferences regarding anatomy modification (e.g., resection planes, resection orientations, resection depths, and osteophyte removal, etc.), implant design, and alignment guide design.

A custom implant is a patient-specific, one-of-a-kind implant specifically made for a particular patient and, consequently, there is no pre-existing inventory associated with such an implant. Custom implants are designed based on the particular patient's anatomy. For example, custom implants can include custom features, such as articulation surfaces and/or bone engagement surfaces, designed based on 3D image data of the patient's anatomy. Off-the shelf or standard implants are available and stocked in a number of sizes, typically six or more, and a number of configurations or types. Standard implants can include standard features, such as standard articulation surfaces and/or bone engagement surfaces. Typical configurations include bilateral or unilateral implants, constrained, semi-constrained, and mobile. Semi-custom implants provide an intermediate solution between custom implants and standard implants. Semi-custom implants can include a combination of custom and non-custom features. For example, semi-custom implants can include standard bone engagement surfaces configured to mate with standard bone cuts and particularized articulation surfaces configured to engage a portion of a particular patient's anatomy. Semi-custom implants reduce the number of implants stocked and the number of molds required for production, while allowing some degree of patient-specific customization.

At 124, the surgeon can request one or more patient-specific alignment guides be used with the implant design recommended at 122. Patient-specific alignment guides can include an inner guide or engagement surface designed to closely conform, mate, and match a joint surface in a unique position, thereby providing a reference. The engagement surface can be a three-dimensional contoured surface configured to nest into a portion of the joint surface in a single location. The reference can be used to guide a drill bit used to form a reference hole and/or implant a k-wire or pin used as a reference. Alternately or additionally, the reference can be used to locate a cutting guide (e.g., four-in-one cutting blocks 372) or other cutting device. Patient-specific alignment guides can be designed based on the three-dimensional model created at 114 using commercially available computer modeling software. Patient-specific alignment guides are more fully described in commonly assigned co-pending application Ser. No. 11/756,057, filed on May 31, 2007, application Ser. No. 11/971,390, filed on Jan. 9, 2008, application Ser. No. 12/025,414, filed on Feb. 4, 2008, and application Ser. No. 12/039,849, filed on Feb. 29, 2008, the disclosures of which are incorporated herein by reference.

At 126, 128, 130, instruments for performing the orthopedic procedure are selected. The instruments can be selected based on various aspects of the pre-operative surgical plan. An initial selection can be made by one or more medical professionals, including the surgeon. Modification and/or approval of the initial selection can be made at 132, discussed in more detail below, where the pre-operative surgical plan is approved. The instruments can be selected from groups including patient-specific instruments, size-specific instruments, and general surgical instruments.

At 126, one or more patient-specific instruments are selected. As used herein, the term patient-specific instrument is used generally to refer to any instrument that includes features designed to match unique features of a particular patient's anatomy. More specifically, a patient-specific instrument can include a three-dimensional contoured surface configured to nest into a portion of a native anatomy in a single location. Patient-specific alignment guides including an inner guide or engagement surface designed to closely conform, mate, and match a particular patient's joint surface are a non-limiting example of a patient-specific instrument. Accordingly, one or more patient-specific instruments can be selected based on, for example, the image information for the patient's anatomy obtained at 112, the model of the joint created at 114, and/or the implant and alignment guide designs selected at 122, 124.

At 128, one or more size-specific instruments are selected. As used herein, the term size-specific instrument is used generally to refer to any instrument belonging to a series of surgical instruments available in graduated sizes. Drill bits of graduated diameters and trial implant components of graduated sizes are two non-limiting examples of size-specific instruments. Size-specific instruments of a particular size or sizes can be selected from a group of size-specific instruments available off-the-shelf in predetermined sizes.

The size-specific instruments can be selected based on, for example, the anatomy modification procedures reviewed at 120, the implant design selected at 122, and/or the alignment guide design selected at 124. When patient-specific alignment guides are selected, the size-specific instruments can be limited to sizes that fit the particular patient. In this way, a number of size-specific instruments selected can be reduced. In particular, a number of trial implant components selected can be reduced. Additionally, a number of size-specific cutting guides can be reduced.

At 130, one or more general surgical instruments are selected. As used herein, the term general instrument is used generally to refer to any instrument that is configured to perform a particular surgical task and is not specifically designed to match unique features of a particular patient's anatomy. For example, pliers configured to hold an attachment, such as a drill guide are one example. Other examples include surgical blades and saws. One or more general surgical instruments can be selected from a group of general surgical instruments available off-the-shelf. The group can include instruments for preparing the anatomy and manipulating (e.g., grasping, displacing, impacting, etc.) the implant and alignment guides. Accordingly, one or more general surgical instruments can be selected based on, for example, the anatomy modification procedures reviewed at 120, the implant design selected at 122, and/or the alignment guide design selected at 124.

At 126, 128, 130, one or more of the patient-specific instruments, size-specific instruments, and general instruments can be a surgeon-specific instrument selected based on a surgeon preference. As used herein, the term surgeon-specific instrument is used generally to refer to any instrument specifically selected based on a particular surgeon's preference. For example, the surgeon may prefer a particular instrument from among the available instruments for performing a particular surgical task. The surgeon may also prefer one procedure among several accepted procedures for performing a particular surgical task. The preferred procedure may require an instrument specifically designed for use with the preferred procedure that is different than other instruments designed for use with the other procedures. For example, the surgeon may prefer one of an I-beam type cruciate stem, a cruciform type cruciate stem, and a tapered cruciate stem, each requiring a unique punch or mills for preparing a tibia for implanting the cruciate stem. As another example, the surgeon may prefer a mallet over a slap hammer.

At 132, the pre-operative surgical plan can be approved. Approval of the pre-operative surgical plan can require approval of the surgeon and/or other users. Specifically, the surgeon can approve the image of the patient's anatomy showing corresponding resection planes. The surgeon can also approve the intra-operative procedures for joint preparation and osteophyte/protrusion removal. The surgeon can further approve the implant to be used and the associated instruments. The implant manufacturer can approve one or more features of the implant design.

At 140, the surgical instruments selected based on the pre-operative surgical plan approved at 110 can be obtained from an instrument manufacturer. At 160 and 170, the alignment guides and the implant and/or trial implant components approved at 110 are prepared by a suitable manufacturer. When preparing a patient-specific instrument, such as a patient-specific alignment guide, a manufacturer may access the image information obtained at 112 and the model created at 114. The alignment guides, implants, and trial implant components can be prepared by various methods and the methods can include cleaning, passivating, and sterilizing.

Patient-specific alignment guides and custom implants approved at 110 for a specific patient can be manufactured for the patient by rapid prototyping methods, such as stereolithography or other similar methods, or by CNC milling, or other automated or computer-controlled machining, or by robotic methods. Manufacturing can take place at a manufacturing center or facility in situ or at remote or off-site location. It will be understood that in situ manufacturing is used as a short hand for a manufacturing site of the original equipment manufacturer (OEM), but can be physically located at a different facility of the OEM. Off-site or remote manufacturing will be understood to refer to facilities operated by other manufacturers who are contracted by the OEM for manufacturing all or some of the implants, components, or parts for the surgical procedure.

Semi-custom implants approved at 110, can be made from a generic casting as more fully described in co-pending application Ser. No. 12/872,663, filed on Aug. 31, 2010, and entitled “Method and Apparatus for Manufacturing an Implant,” the disclosure of which is incorporated herein by reference. Alternately, semi-custom implants can be made by modifying existing standard implant designs to match various features or parameters based on the anatomy of the patient. Such semi-custom implants are more fully described in co-pending application Ser. No. 12/103,834, filed on Apr. 16, 2008, entitled “Patient-Modified Implant And Associated Method,” the disclosure of which is incorporated herein by reference.

Standard implants approved at 110, can be manufactured by standard casting methods from bar stock or other stock material, then shaped to a final shape and size by grinding or milling. Such standard implants can be part of an existing inventory, or mass-produced, or produced by just-in-time manufacturing methods.

At 180, a surgeon instrument kit can be prepared by sterilizing and packaging the various surgical instruments obtained at 140, 160, 170 in a container that holds the instruments in sterilize form until opened. More specifically, the surgeon instrument kit can be prepared to include the patient-specific instruments, size-specific instruments, general surgical instruments, and surgeon-specific instruments selected at 126, 128, 130. According to the present teachings, an exemplary surgeon instrument kit can include at least one each of a patient-specific instrument, a size-specific instrument, a general surgical instrument, and a surgeon-specific instrument. By using patient-specific instruments, the number of size-specific instruments can be limited and the surgeon instrument kit can be prepared to include a reduced number of overall instruments than other conventional kits. A label or other indicia identifying a particular patient can be affixed to the container. FIG. 3, discussed below, illustrates an exemplary surgeon instrument kit according to the present teachings in further detail.

At 190, the surgeon instrument kit can be delivered to a medical facility where the orthopedic procedure is to be performed. The surgeon instrument kit can be delivered just-in-time, or in other words, just prior to a time when the orthopedic procedure is scheduled to be performed. At 200, the surgeon instrument kit can be temporarily stored for retrieval prior to the scheduled time of the orthopedic procedure. The surgeon instrument kit can be stored in a stationary rack at a centralized location of the medical facility separate from an operating room where the orthopedic procedure is to be performed. For example, the centralized location can be a centralized storage area where medical supplies for the entire medical facility are stored.

At 210, replacement instruments to be individually packaged in backup kits at 220 are selected from among the components of the surgeon instrument kit. The replacement instruments can be selected according to various predetermined strategies. In one exemplary strategy, replacement instruments can be selected for each of the instruments of the surgeon instrument kit. In this way, a single, sterilized replacement instrument can be made available to the surgeon in the event any of the instruments of the surgeon instrument kit need to be replaced during the orthopedic procedure without having to provide a kit containing a complete set of instruments. In another exemplary strategy, replacement instruments having a size or sizes different than the sizes of the size-specific instruments of the surgeon instrument kit can be selected from among the various predetermined sizes available. In this way, replacement instruments of a different size than that of the size-specific instruments of the surgeon instrument kit can be individually selected and used by the surgeon. In yet another strategy, replacement instruments for performing an alternate procedure specified by the surgeon can be selected. In this way, replacement instruments for the alternate procedure can be available to a surgeon during a surgery, should the surgeon select the alternate procedure intra-operatively.

For example, FIG. 7 is a perspective view of an individually packaged general surgical instrument. FIG. 7 shows first pin/nail puller 312, which can be a duplicate of first pin nail puller 312 of FIG. 3. FIG. 8 is a perspective view of an individually packaged surgeon-specific instrument. FIG. 8 shows cruciate stem guide 340, which can be a duplicate of cruciate stem guide 340 of FIG. 3. FIG. 9 is a perspective view of an individually packaged patient-specific instrument. FIG. 9 shows tibial alignment guide 384, which can be a duplicate of tibial alignment guide 384 of FIG. 3.

At 220, the backup kits can be prepared by sterilizing and packaging the replacement instruments selected at 210 in containers that hold the instruments in sterilized form until opened. In an exemplary implementation, each of the replacement instruments can be individually packaged in a single container. A label or other indicia identifying each of the replacement instruments can be affixed to the containers.

At 230, the backup kits prepared at 220 can be delivered to the medical facility. The backup kits can be delivered just-in-time. Alternately, or additionally, additional backup kits can be delivered to the medical facility to provide inventory of select replacement instruments that can be used during other orthopedic procedures to be performed on other patients. In various implementations, the backup kits can be delivered together with the surgeon instrument kit as a set. For example, the backup kits can be packaged together with the surgeon instrument kit in a delivery or shipping container. The shipping container can include an interior compartment that holds the containers of the backup kits and the surgeon instrument kit during delivery.

At 240, the backup kits can be stored for retrieval just prior to the scheduled time of the orthopedic procedure. According to the present teachings, the backup kits can be stocked to a mobile storage cart configured to receive the backup kits. In various implementations, the mobile storage cart can include receptacles for the backup kits such as shelves, slots, drawers or a combination thereof. FIGS. 4-5, discussed below, illustrate exemplary mobile storage carts according to the present teachings.

When not in use, the mobile storage cart can be stored in a predetermined designated location such as, for example, in a ward where orthopedic surgeries are performed or a centralized storage area where other medical supplies are stored.

Generally, the mobile storage cart can be moveable between various locations within the medical facility. For example, the mobile storage cart can be movable between the centralized storage area and the ward of the medical facility where the orthopedic procedure is to be performed. The mobile storage cart can also be moveable between operating rooms where orthopedic procedures are performed.

In various implementations, more than one mobile storage cart can be provided. A number of mobile storage carts can be provided based on, for example, a size of the medical facility, a number of orthopedic procedures performed at any one time, and/or a number of different types of orthopedic procedures. More specifically, for example, a mobile storage cart can be provided for each orthopedic procedure to be performed at the same time.

At 250, the surgeon instrument kit is delivered to the surgeon and, more specifically, to the operating room for use during the orthopedic procedure.

At 260, the mobile storage cart can be staged relative to the operating room. In particular, the mobile storage cart can be moved to a location near the operating room providing suitable access during the orthopedic procedure.

Referring now to FIG. 3, an exemplary surgeon instrument kit 300 is presented. Generally, the surgeon instrument kit 300 can be a sealed package containing in a sterilized form a complete set of surgical instruments and implant components necessary or useful for performing an orthopedic procedure. The surgical instruments can be of the non-disposable or disposable type. In various implementations, patient-specific instruments may generally be of the disposable type, while general surgical instruments may generally be of the non-disposable type. The instruments of the surgeon instrument kit can be packaged in a tray 302 having receptacles 304 for receiving one or more of the instruments and sealed by an enclosure or wrapping (not shown). Once delivered to the surgeon, the surgeon instrument kit 300 can be opened by a surgeon or other medical professional.

According to the present teachings, the surgeon instrument kit 300 can include at least one each of a patient-specific instrument, a size-specific instrument, a general surgical instrument, and a surgeon-specific instrument. Generally, more than one instrument or component from each group can be selected. However, a number of size-specific instruments can be limited by limiting the size-specific instruments to a size or sizes expected to fit a particular patient. In various implementations, the size-specific instruments can include the size expected to fit the particular patient and a next size. The surgeon-specific instrument can be one of a patient-specific, a size-specific, and a general surgical instrument selected from a group of similar or alternative instruments based on a surgeon preference.

In an exemplary implementation, the surgeon instrument kit 300 can include instruments and other components for performing an orthopedic procedure. For purposes of the present example, the orthopedic procedure can be a procedure for total replacement of a knee joint with a knee implant. Accordingly, the surgeon instrument kit 300 can include instruments and other components for implanting trial implant components associated with the knee implant. While the surgeon instrument kit 300 is described for an orthopedic procedure for a knee joint, it will be appreciated that the present teachings are not limited to such procedures and can be applied to other surgical procedures.

The general surgical instruments can include a feeler blade 310, a first pin/nail puller 312, a universal cut block 314, a guided drill chuck 318, a universal slap hammer 320, a universal impactor 322, a slap hammer end attachment 324, a laser-assisted pin/nail puller 326, and an alignment handle 328. Other general surgical instruments can include pliers 330 and associated attachments, including lock bars 332 and a drill guide 334.

The surgeon-specific instruments can include a cruciate stem guide 340, a cruciate punch 342, and a control impactor attachment 344 for use with the cruciate punch 342. The size-specific instruments can include trial implant components of various sizes, including femoral trials 352, tibial templates 354, tibial bearing bases 356, tibial bearing spacers 358, and patella trials 360. The size-specific instruments can further include drill guide rings 370 for the patella trials 360, four-in-one cutting blocks 372 of various sizes, drill pins 374 of various diameters and/or lengths, and a drill bit 376 of a particular diameter. Other size-specific instruments can include surgical nails 378.

The patient-specific instruments can include a tibia bone model 380, a femur bone model 382, a tibial alignment guide 384, and a femoral alignment guide 386. The tibia and femur bone models 380, 382 and the tibial and femoral alignment guides 384, 386 can have patient-specific mating surfaces.

Referring now to FIG. 4, an exemplary mobile storage cart 400 according to the present teachings is presented. Generally, the mobile storage cart 400 can be configured to store backup kits 402 for one or more surgeon instrument kits, such as the surgeon instrument kit 300 discussed above. The mobile storage cart 400 can also be configured to be moved from place to place within a medical facility by medical facility personnel. More specifically, the mobile storage cart 400 can be staged relative to an operating room. In this way, the mobile storage cart 400 can serve as a backup by providing access to individually packaged replacement instruments for instruments of the surgeon instrument kits used in the operating room. The mobile storage cart 400 can also make additional instruments, for example instruments of different sizes, individually accessible during a surgery performed in the operating room.

In an exemplary implementation, the mobile storage cart 400 can include a plurality of shelves 404 supported on wheels 406. A number, size, and placement of the shelves 404 can be based on a number, a size, and a desired arrangement of the backup kits 402 to be stored. The desired arrangement can vary depending on whether the mobile storage cart 400 will be used to service a single surgical procedure or multiple surgical procedures. One or more of the shelves can be further configured to receive one or more surgeon instrument kits. In this way, the mobile storage cart can be configured to store and move both surgeon instrument kits and associated backup kits together. One or more of the shelves 404 can include partitions 408 for separating the backup kits 402 and/or maintaining the desired arrangement. The wheels 406 can include locks selectively engageable to inhibit rotation of the wheels 406 and thereby enable the mobile storage cart 400 to be temporarily fixed in position.

The mobile storage cart 400 can further include a tray 410 and a display or tag 412. The tray 410 can be configured to store, for example, smaller ones of the backup kits 402. The tag 412 can communicate various information. For example, the tag 412 can communicate information identifying the mobile storage cart 400, its contents and the desired arrangement of the contents, and/or a patient or patients for whom the mobile storage cart 400 has been prepared.

Referring now to FIG. 5, another exemplary mobile storage cart 500 configured for backup kits 502 is presented. The mobile storage cart 500 includes a cabinet 504 supported on wheels 506. The cabinet 504 can include a plurality of drawers 508 configured to receive one or more of the backup kits 502. The drawers 508 can have various sizes and arrangements within the cabinet 504. Each of the drawers 508 can have a handle or pull 510 for opening and closing and a label 512 identifying the contents. A display or tag 514 can be affixed to the outside of the cabinet 504 and can communicate various information about the mobile storage cart 500, similar to the tag 412 discussed above.

Referring now to FIG. 6, an exemplary method 600 for performing surgical procedures for particular patients according to the present teachings is presented. Generally, the method 600 includes performing the surgical procedures at a medical facility using surgeon instrument kits and a mobile storage cart containing backup kits according to the present teachings. The surgeon instrument kits, the backup kits, and the mobile storage cart can be prepared according to the method 100 discussed above. Accordingly, it will be appreciated that the method 600 can be used with the surgeon instrument kit 300, the mobile storage carts 400, 500, and the backup kits 402, 502 discussed above. While the method 600 is generally described with reference to a single mobile storage cart, it will be appreciated that the method 600 can employ more than one mobile storage cart.

The method 600 begins at 602 where the mobile storage cart can be stored at a predetermined first designated location within the medical facility when not in use during the surgical procedures. The first designated location can be a centralized storage area where medical supplies for the entire medical facility are stored. Alternately, the first designated location can be a location within a particular ward of the medical facility where surgical procedures are performed.

At 604, the medical facility can receive surgeon instrument kits for the surgical procedures to be performed. At 606, the surgeon instrument kits can be stored for retrieval prior to scheduled times when the surgical procedures are to be performed. The surgeon instrument kits can be stored at a predetermined second designated location within the medical facility. The second designated location can be the same as or different than the first designated location where the mobile storage cart is stored at 602. In various implementations, one or more of the surgeon instrument kits can be stored on the mobile storage cart.

At 608, the medical facility can receive the backup kits for each of the surgeon instrument kits received at 604. At 610, the backup kits for at least a next scheduled surgical procedure can be stocked to the mobile storage cart. In various implementations, the backup kits for two or more of the scheduled surgical procedures can be stocked to the mobile storage cart at the same time. The backup kits can be stocked by medical facility personnel according to a predetermined arrangement. When stocking the mobile storage cart, the medical facility personnel can refer to a tag (e.g., tags 412, 512) communicating the arrangement. The medical facility personnel can refer to the tag to confirm the particular patient or patients for whom the mobile storage cart is being stocked, or can update the tag to identify the particular patient or patients.

At 612, the surgeon instrument kit for the next scheduled surgical procedure can be delivered to a surgeon. More specifically, the surgeon instrument kit can be delivered to an operating room where the surgeon is to perform the next scheduled surgical procedure. In various implementations, delivery may be facilitated by the mobile storage cart. For example, the surgeon instrument kit may be placed on the mobile storage cart and wheeled to a location within or just outside the operating room.

At 614, the mobile storage cart can be staged relative to the operating room. In particular, the mobile storage cart can be moved to a predetermined third designated location providing suitable access to the mobile storage cart during the scheduled surgery. In various implementations, the third designated location can be different than the second designated location where the mobile storage cart is stored at 602 and can be a location within or just outside the operating room. During staging, the tag may be updated to indicate the mobile storage cart is in use.

During the scheduled surgery, backup kits can be selectively removed from the mobile storage cart and delivered to the surgeon as required at 616. The backup kits can be selectively removed to replace corresponding instruments or components of the surgeon instrument kit that have been, for example, contaminated, dropped, damaged, or are found defective during the scheduled surgery.

At 618, a decision whether the mobile storage cart is to return to storage can be made. The decision can be made by the medical facility personnel responsible for managing the cart. If the mobile storage cart is to return to storage, then the method 600 can proceed at 620-622, otherwise the method 600 can return to 610 as shown. The method 600 may return to 610 and proceed at 610-616 for the next scheduled surgery as already described above.

At 620, the mobile storage cart is returned to the first designated location where the mobile storage cart is stored when not in use. At 622, unused backup kits can be removed from the mobile storage cart and can be stored, for example, in the centralized storage area. Alternately or additionally, selected backup kits can be returned to the manufacturer.

Alternately, at 624, the mobile storage cart can be restocked with backup kits maintained in inventory on the mobile storage cart. For example, instruments which are not patient-specific and/or are not size-specific may be maintained in inventory on the mobile storage cart. In this way, the number of backup kits that are prepared for particular patients can be reduced.

The foregoing discussion discloses and describes merely exemplary arrangements of the present teachings. Furthermore, the mixing and matching of features, elements and/or functions between various embodiments is expressly contemplated herein, so that one of ordinary skill in the art would appreciate from this disclosure that features, elements and/or functions of one embodiment may be incorporated into another embodiment as appropriate, unless described otherwise above. Moreover, many modifications may be made to adapt a particular situation or material to the teachings of the invention without departing from the essential scope thereof. One skilled in the art will readily recognize from such discussion, and from the accompanying drawings and claims, that various changes, modifications and variations can be made therein without departing from the spirit and scope of the present teachings as defined in the following claims. 

What is claimed is:
 1. A method of preparing a surgical instrumentation package for use during a surgical procedure, the method comprising: evaluating bone or joint image files of a patient including a bone or joint for repairing during a surgical procedure to determine bone or tissue that needs to be removed, restored or repaired during the surgical procedure; preparing a preliminary pre-operative surgical plan for evaluating the bone or joint, the pre-operative surgical plan including information stored in a non-transitory tangible storage medium for: multiple accepted procedures among several alternative accepted procedures for performing the surgical procedure; multiple surgical tasks such as those for performing various bone resections; various sizes and types of implants; and multiple accepted instruments from among several alternative accepted instruments for performing an equivalent surgical task; selecting a final pre-operative surgical plan from the preliminary pre-operative surgical plan, the final pre-operative surgical plan including: a surgeon-specific procedure selected from the multiple accepted procedures; a surgeon-specific task for performing one of the various bone resections; a surgeon-selected implant for use with the one of the various bone resections; and a surgeon-specific instrument selected from the multiple accepted instruments; packaging the surgeon-specific instrument along with other general surgical instruments required to complete the surgeons-specific procedure into a single package; and individually packaging one of the multiple accepted instruments from among several alternative accepted instruments for performing an equivalent surgical task not selected to be the surgeon-specific instrument in a backup instrument package separate from the single package.
 2. The method of claim 1, wherein the various sizes and types of implants include a patient-specific implant.
 3. The method of claim 1, wherein the multiple accepted instruments from among several alternative accepted instruments from performing an equivalent surgical task comprise: a reusable general instrument; and a disposable patient-specific instrument.
 4. The method of claim 1, wherein the surgeon-specific task is selected from a plurality of alternative accepted tasks suitable for use with the selected surgeon-specific procedure.
 5. The method of claim 4, wherein the surgeon-specific implant is selected from a plurality of alternative accepted implants suitable for use with the selected surgeon-specific task.
 6. The method of claim 4, wherein the surgeon-specific instrument selected from a plurality of alternative accepted instruments suitable for use with the selected surgeon-specific task.
 7. The method of claim 1, further comprising displaying the multiple accepted procedures among several alternative accepted procedures for performing the surgical procedure, the multiple surgical tasks such as those for performing various bone resections, the various sizes and types of implants, and the multiple accepted instruments from among several alternative accepted instruments for performing an equivalent surgical task as options on a display device in communication with the non-transitory tangible storage medium.
 8. The method of claim 7, wherein selecting the final pre-operative surgical plan comprises receiving, via a user input device, selected options for the final pre-operative plan, the user input device in communication with the non-transitory tangible storage medium and the display device.
 9. The method of claim 1, further comprising providing in the preliminary pre-operative surgical plan: a recommended procedure selected from the multiple accepted procedures; a recommended task for performing one of the various bone resections; a recommended implant for use with the one of the various bone resections; and a recommended instrument selected from the multiple accepted instruments; wherein at least one of the surgeon-specific procedure; the surgeon-specific task, the surgeon-selected implant, and the surgeon-specific instrument is different than the recommended procedure, the recommended task, the recommended implant and the recommended instrument, respectively.
 10. The method of claim 1, further comprising shipping the single package to a surgical facility where the surgical procedure is to be performed.
 11. The method of claim 1, further comprising staging the backup instrument package in a cart relative to an operating room at the surgical facility for the surgical procedure.
 12. A method for preparing a surgical instrumentation package for use during a surgical procedure, the method comprising: preparing a preliminary pre-operative surgical plan for evaluating a bone or joint, the pre-operative surgical plan including information stored in a non-transitory tangible storage medium for performing a surgical task; selecting one of first and second instruments for performing the surgical task; packaging the selected instrument within a surgical kit containing other surgical instruments; and individually packaging the non-selected instrument in a back-up package.
 13. The method of claim 12, wherein the first and second instruments for performing the surgical task are alternative accepted instruments for performing the surgical task.
 14. The method of claim 12, wherein one of the first and second instruments comprises a patient specific-instrument.
 15. The method of claim 12, wherein the first instrument comprises a reusable general instrument, and the second instrument comprises a disposable patient-specific instrument.
 16. The method of claim 12, further comprising presenting the first and second instruments as options on a display device in communication with the non-transitory storage medium.
 17. The method of claim 16, further comprising inputting the selected one of the first and second instruments into a user input device in communication with the non-transitory storage medium.
 18. The method of claim 12, wherein selecting one of first and second instruments for performing the surgical task further comprises providing a recommended instrument from the first and second instruments for performing the surgical task.
 19. The method of claim 18, wherein the selected one of the first and second instruments is different than the recommended instrument.
 20. A method for preparing a surgical instrumentation package for use during a surgical procedure, the method comprising: preparing a preliminary pre-operative surgical plan for evaluating a bone or joint, the pre-operative surgical plan including information stored in a non-transitory tangible storage medium for performing a surgical task; presenting first and second instruments as options on a display device in communication with the non-transitory storage medium; selecting one of the first and second instruments for performing the surgical task; packaging the selected instrument within a surgical kit containing other surgical instruments; and individually packaging the non-selected instrument in a back-up package; wherein the first instrument comprises a reusable general instrument, and the second instrument comprises a disposable patient-specific instrument. 